<%@ Page Title="CUPS Follow-Up" Language="vb" AutoEventWireup="false" MasterPageFile="~/Content/Site.Master" CodeBehind="follow_up.aspx.vb" Inherits="CupsApp.Web.Form.follow_up" %>
<%@ Register assembly="wwDataBinder" namespace="MsdnMag.Web.Controls" tagprefix="ww" %>
<asp:Content ID="Content1" ContentPlaceHolderID="head" runat="server">
</asp:Content>
<asp:Content ID="Content2" ContentPlaceHolderID="ContentPlaceHolder1" runat="server">
<div class="tabs">
 <div class="tab"><asp:LinkButton ID="lnkPersonal" Text = "Personal"  runat="server" ></asp:LinkButton></div> <div class="tab"><asp:LinkButton ID="lnkBackground" Text = "Background" runat="server"></asp:LinkButton></div> <div class="tab"><asp:LinkButton ID="lnkHealthLegal" Text = "Health / Legal" runat="server"></asp:LinkButton></div> 
 <div class="tab"><asp:LinkButton ID="lnkHousing" Text = "Housing" runat="server"></asp:LinkButton></div><div class="tabSelected"><asp:LinkButton ID="lnkFollowUp" Enabled = "false" Text = "Follow-Up" runat="server"></asp:LinkButton></div><div class="tab"><asp:LinkButton ID="lnkStatus" Text = "Status" runat="server"></asp:LinkButton></div><div class="tab"><asp:LinkButton ID="lnkExit" Text = "Exit" runat="server"></asp:LinkButton></div>
</div>


<div class="Content">
<div class="filler">
         <center> <strong><asp:Label ID="lvlMsg" runat="server" ForeColor="#00CC00" ></asp:Label></strong></center></div><div class="filler"></div>
  <div class="FullRow1"> 
    <div class="HalfRow3">
        <asp:Label ID="Label12" runat="server" Text="Follow-up Interview Date:"></asp:Label>
    &nbsp;


        <asp:CheckBox ID="CheckBox220" runat="server" Text="3 months" 
            AutoPostBack="True"  Checked="true"/>
&nbsp;
        <asp:CheckBox ID="CheckBox221" runat="server" Text="6 months" 
            AutoPostBack="True" />
&nbsp;
        <asp:CheckBox ID="CheckBox222" runat="server" Text="9 months" 
            AutoPostBack="True" />
    </div>
    <div class="ContentRow1">
    <asp:Label ID="lblClientID" runat="server" Text="Client ID:"></asp:Label>
    </div>
    <div class="ContentRow2">
    <asp:TextBox ID="txtClientID" runat="server"></asp:TextBox>
    </div>
  </div>
   <div class="FullRow1">
   <hr>
   </div>
   <div class="FullRow1">
    <div class="ContentRow1">
        <asp:Label ID="Label2" runat="server" Text="Salutation:"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtSalutation" runat="server"></asp:TextBox>
    </div>
    <div class="ContentRow1">
        <asp:Label ID="Label4" runat="server" Text="Suffix:"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtSuffix" runat="server"></asp:TextBox>
    </div>
  </div> 
  <div class="FullRow1"> 
    <div class="ContentRow1">
        <asp:Label ID="Label5" runat="server" Text="First Name:"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtFirstName" runat="server"></asp:TextBox>
    </div>
    <div class="ContentRow1">
    <asp:Label ID="Label6" runat="server" Text="Last Name:"></asp:Label>
    </div>
    <div class="ContentRow2">
    <asp:TextBox ID="txtLastName" runat="server"></asp:TextBox>
    </div>
  </div>
  <div class="FullRow1">
    <div class="ContentRow1">
        <asp:Label ID="Label7" runat="server" Text="Middle Name:"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtMiddleName" runat="server"></asp:TextBox>
    </div>
  </div>  
   <div class="FullRow1">
     <div class="filler"></div>
     <div class="FormHeading">
         <strong><asp:Label ID="lblRehoused" runat="server" Text="WAS THE CLIENT REHOUSED WITHIN THE LAST 3 MONTHS?"></asp:Label></strong>
    </div>
  </div> 
  <div class="filler"></div>
   <div class="FullRow1">
    <div class="ContentRow2">
        <asp:CheckBox ID="chkRehoused1" runat="server" Text="Yes" />
        <asp:CheckBox ID="chkRehoused2" runat="server" Text="No" />
    </div>
    <div class="ContentRow2">
    </div>
    <div class="ContentRow1">
    </div>
    <div class="ContentRow2">
    </div>
  </div>  
  <div class="FullRow1">
     <div class="FormHeading">
            <strong><asp:Label ID="lblAttending" runat="server" Text="ARE YOU CURRENTLY ATTENDING ANY OF THE FOLLOWING?"></asp:Label></strong>
    </div>
  </div> 
<div class="FullRow1">
    <div class="HalfRow2">
        <asp:CheckBox ID="chkAttending1" runat="server" 
            Text="Employment related training ( part - time )" />
    </div>
    <div class="HalfRow2">
        <asp:CheckBox ID="chkAttending2" runat="server" 
            Text="Employment related training ( full - time )" />
    </div>
  </div> 
  <div class="FullRow1"> 
    <div class="HalfRow2">
        <asp:CheckBox ID="chkAttending3" runat="server" 
            Text="Further Education ( part - time )" />
    </div>
    <div class="HalfRow2">
        <asp:CheckBox ID="chkAttending4" runat="server" 
            Text="Further Education ( full - time )" />
    </div>

  </div>
  <div class="FullRow1">
     <div class="FormHeading">
            <strong><asp:Label ID="lblIncome" runat="server" Text="CURRENT SOURCE OF INCOME ( Check all that apply )"></asp:Label></strong>
    </div>
  </div> 
<div class="FullRow1">
    <div class="ContentRow2">
        <asp:CheckBox ID="chkIncome1" runat="server" Text="AISH" />
    </div>
    <div class="ContentRow5">
        <asp:CheckBox ID="chkIncome2" runat="server" 
            Text="Alberta Works / Income Support" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkIncome3" runat="server" Text="Employment Insurance (EI)" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkIncome4" runat="server" Text="Pension" />
    </div>
  </div> 
  <div class="FullRow1"> 
    <div class="ContentRow2">
        <asp:CheckBox ID="chkIncome5" runat="server" Text="Full-time Employment" />
    </div>
    <div class="ContentRow5">
        <asp:CheckBox ID="chkIncome6" runat="server" Text="Part-time Employment" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkIncome7" runat="server" Text="No Income" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkIncome8" runat="server" Text="Other" />
    </div>
  </div>
   <div class="FullRow1">
     <div class="filler"></div>
     <div class="FormHeading">
         <strong><asp:Label ID="lblDiagnosed" runat="server" Text="HAVE YOU BEEN DIAGNOSED WITH ANY OF THE FOLLOWING IN THE LAST 3 MONTHS ( Check all that apply )"></asp:Label></strong>
    </div>
  </div> 
  <div class="filler"></div>
   <div class="FullRow1">
    <div class="ContentRow2">
        <asp:CheckBox ID="chkDiagnosed1" runat="server" Text="HIV / AIDS" />
    </div>
    <div class="ContentRow5">
        <asp:CheckBox ID="chkDiagnosed2" runat="server" Text="Physical Health Issues" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkDiagnosed3" runat="server" Text="Mental Health Issues" />
    </div>
    <div class="ContentRow2">
    </div>
    </div>
     <div class="FullRow1">
     <div class="filler"></div>
     <div class="FormHeading">
         <strong><asp:Label ID="lblTreatmentFor" runat="server" Text="ARE YOU CURRENTLY PARTICIPATING IN ACTIVE TREATMENT FOR ANY OF THE FOLLOWING ( Check all that apply )"></asp:Label></strong>
    </div>
  </div> 
  <div class="filler"></div>
   <div class="FullRow1">
    <div class="ContentRow2">
        <asp:CheckBox ID="chkTreatmentFor1" runat="server" Text="HIV / AIDS" />
    </div>
    <div class="ContentRow5">
        <asp:CheckBox ID="chkTreatmentFor2" runat="server" Text="Physical Health Issues" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkTreatmentFor3" runat="server" Text="Mental Health Issues" />
    </div>
    <div class="ContentRow2">
        <asp:CheckBox ID="chkTreatmentFor4" runat="server" Text="Addictions" />
    </div>
  </div>
  <div class="FullRow1">
     <div class="filler"></div>
     <div class="FormHeading">
         <strong><asp:Label ID="Label8" runat="server" Text="HEALTH"></asp:Label></strong>
    </div>
  </div> 
  <div class="filler"></div><div class="filler"></div>
 <div class="FullRow1">
    <div class="ContentRow6">
        <asp:Label ID="lblTimesHospital" runat="server" 
            
            Text="How many days in total have you spent hospitalized in the past 3 months? "></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtTimesHospital" runat="server"></asp:TextBox>
        </div>
</div>

 <div class="FullRow1">
    <div class="ContentRow6">
        <asp:Label ID="lblTimesEMS" runat="server" 
            Text="How many times have you utilize the Emergency Medical Service ( EMS ) in the past 3 months?"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtTimesEMS" runat="server"></asp:TextBox>
        </div>
</div>
 
  <div class="FullRow1">
    <div class="ContentRow6">
        <asp:Label ID="lblTimesER" runat="server" 
            Text="How many time have you been to the hospital emergency room in the past 3 months?"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtTimesER" runat="server"></asp:TextBox>
        </div>
</div>
 <div class="filler"></div>
  <div class="FullRow1">
    
     <div class="FormHeading">
            <strong><asp:Label ID="lblFirstLanguage" runat="server" 
                Text="JUSTICE AND LEGAL"></asp:Label></strong>
    </div>
  </div> 
<div class="filler"></div>
 <div class="FullRow1">
    <div class="ContentRow6">
        <asp:Label ID="lblTimesJail" runat="server" 
            Text="How many days have you spent in jail in the past 3 months? "></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtTimesJail" runat="server"></asp:TextBox>
        </div>
</div>

 <div class="FullRow1">
    <div class="ContentRow6">
        <asp:Label ID="lblTimesPolice" runat="server" 
            
            Text="How many times have you had interaction with the police in the past 3 months?"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtTimesPolice" runat="server"></asp:TextBox>
        </div>
</div>
 
  <div class="FullRow1">
    <div class="ContentRow6">
        <asp:Label ID="lblTimesCourt" runat="server" 
            Text="How many court appearances have you had in the past 3 months?"></asp:Label>
    </div>
    <div class="ContentRow2">
        <asp:TextBox ID="txtTimesCourt" runat="server"></asp:TextBox>
        </div>
</div>
  <div class="FullRow1">
     <hr/>
     <center><asp:Button ID="btnSave" runat="server" Text="Save" Width="83px" /></center>
  </div>
     <asp:HiddenField ID="Client_ID" runat="server" />
  <br />

</div>
        <ww:wwDataBinder ID="wwDataBinder1" runat="server">
            <DataBindingItems>
                <ww:wwDataBindingItem ID="WwDataBindingItem1" runat="server" ControlId="txtClientID" BindingMode="OneWay" 
                    BindingSource="_data" BindingSourceMember="ClientID">
                </ww:wwDataBindingItem>
                <ww:wwDataBindingItem ID="WwDataBindingItem3" runat="server" ControlId="txtSalutation" BindingMode="OneWay" 
                    BindingSource="_data" BindingSourceMember="Salutation">
                </ww:wwDataBindingItem>
                <ww:wwDataBindingItem ID="WwDataBindingItem4" runat="server" ControlId="txtSuffix" BindingMode="OneWay" 
                    BindingSource="_data" BindingSourceMember="Suffix">
                </ww:wwDataBindingItem>
                <ww:wwDataBindingItem ID="WwDataBindingItem5" runat="server" ControlId="txtFirstName" BindingMode="OneWay" 
                    BindingSource="_data" BindingSourceMember="FirstName">
                </ww:wwDataBindingItem>
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</asp:Content>  